Impact of chronic obstructive pulmonary disease on 10-year mortality after percutaneous coronary intervention and bypass surgery for complex coronary artery disease: insights from the SYNTAX Extended Survival study

Abstract

Aims: To evaluate the impact of chronic obstructive pulmonary disease (COPD) on 10-year all-cause death and the treatment effect of CABG versus PCI on 10-year all-cause death in patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) and COPD.

Methods: Patients were stratified according to COPD status and compared with regard to clinical outcomes. Ten-year all-cause death was examined according to the presence of COPD and the revascularization strategy.

Results: COPD status was available for all randomized 1800 patients, of whom, 154 had COPD (8.6%) at the time of randomization. Regardless of the revascularization strategy, patients with COPD had a higher risk of 10-year all-cause death, compared with those without COPD (43.1% vs. 24.9%; hazard ratio [HR]: 2.03; 95% confidence interval [CI]: 1.56-2.64; p < 0.001). Among patients with COPD, CABG appeared to have a slightly lower risk of 10-year all-cause death compared with PCI (42.3% vs. 43.9%; HR: 0.96; 95% CI: 0.59-1.56, p = 0.858), whereas among those without COPD, CABG had a significantly lower risk of 10-year all-cause death (22.7% vs. 27.1%; HR: 0.81; 95% CI: 0.67-0.99, p = 0.041). There was no significant differential treatment effect of CABG versus PCI on 10-year all-cause death between patients with and without COPD (p interaction = 0.544).

Conclusions: COPD was associated with a higher risk of 10-year all-cause death after revascularization for complex coronary artery disease. The presence of COPD did not significantly modify the beneficial effect of CABG versus PCI on 10-year all-cause death.

Trial registration: SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050.

Keywords: All-cause death; Chronic obstructive pulmonary disease; Coronary artery bypass grafting; Percutaneous coronary intervention; SYNTAX.

Conflict of interest statement

Dr. Serruys reports personal fees from Biosensors, Micel Technologies, Sinomedical Sciences Technology, Philips/Volcano, Xeltis, and HeartFlow, outside the submitted work. Dr. van Geuns reports personal fees from Abbott vascular, grants and personal fees from AstraZeneca, grants and personal fees from Amgen, grants and personal fees from Boston Scientific, personal fees from Sanofi, outside the submitted work. Dr. Morice reports to work as the CEO of CERC, a CRO which was never involved in the SYNTAX trial at any level, except that submitted the 10 years additional follow-up (for free) to French authorities to get approval. Dr. Morice also reports to work as minor shareholder of electroducer. Dr. Burzotta reports speaker’s fees from Abiomed, Abbott and Medtronic. Dr. Kappetein reports to work as an employee of Medtronic, outside the submitted work. Dr. James’s institution has received research grants from Boston Sc, Abbot, Biotronik, Medtronic, Astra Zeneca, Bayer, Jansen, The MedCo, and has received lecture fees from Biotronik, Astra Zeneca. All other authors have no disclosures.

Figures

Fig. 1

Kaplan–Meier curves for all-cause death at 10 years in patients with (red) or without (blue) COPD among the overall cohort, the PCI arm and the CABG arm. a 10-year all-cause mortality according to COPD in the overall cohort. b 10-year all-cause mortality according to COPD in the PCI arm. c 10-year all-cause mortality according to COPD in the CABG arm. Event rates represent Kaplan–Meier estimates

Fig. 2

Kaplan–Meier curves for all-cause death at 10 years in patients randomized to PCI (blue) vs. CABG (red) among patients with and without COPD. a All-cause mortality at 10 years in patients with COPD. b All-cause mortality at 10 years in patients without COPD. Event rates represent Kaplan–Meier estimates